对糖尿病足溃疡诱因与发生部位的临床观察

Clinical observation on predisposing factors and recurrence sites of diabetic foot ulcer

目的通过对糖尿病足溃疡诱因与部位的观察为糖尿病足的防控提供依据。方法回顾性分析2019年1月至2021年9月华中科技大学同济医学院附属梨园医院创面修复中心收治的230例糖尿病足住院患者的病历资料。收集信息包括患者性别、年龄、居住地、基础疾病、起始发病时是否合并其他疾病、足部溃疡的诱因和部位等情况。数据比较采用χ^(2)检验和Kruskal-Wallis H检验。结果(1)由于日常生活及保健行为引起足部溃疡112例,占48.70%;无明确诱因出现溃疡69例,占30.00%;由于皮肤瘙痒、干燥皲裂、水肿、鸡眼等并发症引起49例,占21.30%。患者足溃疡多为复发(178例,占77.39%),其中由不适当的日常生活及保健行为导致的足溃疡复发为98例,占42.61%,足溃疡的诱因对复发的影响大于初发,差异有统计学意义(χ^(2)=12.759,P<0.05)。(2)230例糖尿病足溃疡患者中,复发溃疡患者中多数发病部位为足背(119例,51.74%),其次为足底(40例,占17.39%),足背足底同时存在19例,占8.26%;复发溃疡患者多数发病部位为足背,初发与复发溃疡发病部位比较,差异有统计学意义(χ^(2)=12.349,P<0.05)。(3)由于不适当的日常生活及保健行为引起溃疡的112例患者中77例患者发生在足背,占33.48%;不同溃疡部位与诱因比较,差异有统计学意义(χ^(2)=25.934,P<0.001)。(4)198例(86.09%)溃疡发生于前足,其次21例(9.13%)发生于后足,溃疡发生于两个区域及以上8例(3.48%),少数发生于中足,仅为3例(1.30%);比较溃疡的发病部位和发病位置,溃疡多发生于前足的足背处,差异有统计学意义(χ^(2)=23.530,P<0.05)。结论糖尿病足溃疡的发生多为复发,复发多位于前足,且足背多于足底,复发诱因多为不适当的日常生活及保健行为,为糖尿病足复发的预防提供依据。

Objective To study the inducement and location of diabetes foot ulcer,it provide a basis for the prevention and control of diabetes foot.Methods Data of 230 inpatients with diabetic foot admitted to wound Repair Center of Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2019 to September 2021 were retrospectively analyzed.Collected the information includes the patient′s gender,age,place of residence,underlying diseases,whether other diseases were present at the time of onset,the cause and location of foot ulcers,and risk factors.Data were compared byχ^(2)test and Kruskal-Wallis H test.Results(1)112 cases of foot ulcer caused by daily life and health care behavior,accounting for 48.70%of the total number;there were 69 cases of ulcers without obvious inducements,accounting for 30.00%;49 cases(21.30%)were caused by itching,dry chapped skin,edema,corns and other complications.Foot ulcers in 178 cases were recurrent,accounted for 77.39%,in which 98 cases caused by inadequate health and daily life behavior,accounting for 42.61%.The inducement of foot ulcers had a greater impact on recurrence than initial onset,the difference was statistically significant(χ^(2)=12.759,P<0.05).(2)Among the 230 patients with diabetic foot ulcer,119 cases(51.74%)of the patients with recurrent ulcer were the dorsum of the foot,followed by 40 cases(17.39%)of the plantar,19 cases(8.26%)of the dorsum and plantar.The majority of patients with recurrent ulcers suffered from the dorsum of the foot,there was statistically significant difference in the location of onset between initial and recurrent ulcers(χ^(2)=12.349,P<0.05).(3)112 cases were caused by inappropriate daily life and health care behavior,and 77 cases(33.48%)occurred in the dorsum of the foot.Compared different ulcer site with incentive,the difference was statistically significant(χ^(2)=25.934,P<0.001).(4)198 cases(86.09%)of ulcers occurred on the forefoot,followed by 21 cases(9.13%)of the hind foot,8 cases(3.48%)in two or more areas,only 3 cases of patients′ulcers occurred in the midfoot,accounting for 1.30%.Comparing the incidence site and location of ulcers,ulcers often occured at the dorsum of the forefoot,with a statistically significant difference(χ^(2)=23.530,P<0.05).Conclusion Diabetes foot ulcer is more recurrent,the recurrence of diabetes foot ulcer is mostly located in the forefoot,and the dorsum of the foot is more than the sole of the foot.The inducement of recurrence is mostly inappropriate daily life and health care behavior,which provides a basis for the prevention of diabetes foot recurrence.